What happens if my condition gets worse after I settle my workers' compensation case?

Depending on the nature of your workers' comp settlement and the laws in your state, you might be able get paid for further medical treatment and disability benefits. You might also have a new workplace injury on top of the old one.

Question

A few years ago, I was working in a shipping warehouse when a coworker caused a heavy box to fall on me. I had some pretty severe back pain and received treatment for about a year, mostly injections and physical therapy. At the time, my doctor said that I wasn’t a candidate for surgery, so I settled my workers’ compensation case. But my back pain has gotten much worse in the last few months. I saw my doctor, who thinks the pain is due to my work injury. Now, my doctor recommends surgery. Can I get compensated through workers’ comp?

Answer

Depending on the wording and terms of your workers' comp settlement, you may be able to get reimbursed for the cost of the surgery and other necessary treatment. If the settlement specified that you would be compensated for future medical expenses, you can submit your bill for surgery or other medical treatment for reimbursement. But you'll need to reopen your workers' comp case if you want to get temporary disability or permanent disability benefits in addition to the medical costs. Most states allow injured workers to reopen their claims if there’s medical evidence that their injuries have gotten significantly worse (and there was no other injury or other intervening cause). Each state has its own time limits and other restrictions on reopening a claim.

If you signed a full and final release of all claims, however, you probably won’t be able to reopen your case to get disability benefits or reimbursement for medical costs. In most states, a settlement with a full and final release means that you’re giving up the right to bring any future claims having to do with your injury. Unless your state has a law making it illegal for workers to waive their right to future medical care, you may get around the release only by proving fraud—that is, showing that your employer or the insurance company intentionally misrepresented the terms of the settlement. Because it can be difficult or impossible to reopen a closed claim, injured workers should think carefully before accepting any type of settlement.

Of course, if your back pain qualifies as a “new” injury, you can file a new workers’ compensation claim. To qualify, there would have to be some type of incident or other working conditions that caused the new injury—for instance, if your current work duties exacerbated your back condition. (Workers' comp may cover injuries and illnesses that aggravate or "light up" a pre-existing condition, as long as the new injury is work-related.)

It can be difficult to tell whether an injury is new or not. Also, the rules for reopening claims after a settlement will depend on state law and the specific terms of your agreement. So you should consult with an experienced workers’ comp attorney if you want to reopen your case or file a new claim.

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